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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING

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The Quarterly Journal of Nuclear Medicine 2001 March;45(1):78-83

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Bone pain palliation with Strontium-89 in cancer patients with bone metastases

Giammarile F. *, Mognetti T. **, Resche I. ***

From the Nuclear Medicine Department, *Centre Léon Bérard, Lyon, France **Centre Hospitalier Universitaire Edouard Herriot, Lyon, France ****Centre René Gauducheau, Nantes, France


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Strontium-89 is a ­pure ­β-emit­ting radio­iso­tope, a chem­i­cal ana­logue of cal­cium, and it is there­fore avid­ly con­cen­trat­ed by are­as of ­high oste­o­blas­tic activ­ity. Selective ­uptake and pro­longed reten­tion at ­sites of ­increased ­bone min­er­al turn­over pro­vide pre­cise ­bone ­lesions tar­get­ing. 89Sr chlo­ride (com­mer­cial­ised as Metastron®) is typ­i­cal­ly admin­is­tered in a sin­gle 150 MBq paren­ter­al ­dose. Its radio­ac­tive emis­sion pos­es ­very lit­tle radio­pro­tec­tion con­cerns. Overall, stud­ies ­show ­pain ­relief in up to 80% of ­patients, of ­which 10 to 40% ­became effec­tive­ly ­pain ­free. The ­mean dura­tion of pal­li­a­tion was 3-4 ­months. The mech­a­nism of ­pain ­relief is con­tro­ver­sial ; it is prob­ably, but not ­only, relat­ed to the ­absorbed ­dose in the ­tumour and ­bone. There is no ­clear ­dose-­response rela­tion­ship. The ­only report­ed tox­ic­ity is tem­po­rary mye­lo­sup­pres­sion. WBC and plate­lets ­should be mon­i­tored at ­least on a week­ly ­basis ­until ­they ­return to base­line. It ­seems ­that ­only ­patients ­with a rea­son­ably ­good gen­er­al con­di­tion ­stand to ben­e­fit ­from ­this treat­ment. In con­clu­sion, system­ic radio­nu­clide ther­a­py ­using 89Sr rep­re­sents a fea­sible, ­safe, effec­tive, ­well tol­er­at­ed and ­cost-effec­tive pal­li­a­tive treat­ment in ­patients ­with refrac­to­ry ­bone ­pain.

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